HCPro, JustCoding Outpatient - 2016 Issue 36 (September)
Q&A: Monitoring drug payments subject to quarterly updates
September 27th, 2016
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Article Overview
This article is a coding and revenue integrity Q&A for outpatient pharmacy and hospital billing staff who need to review payment for drugs and biologicals under quarterly update cycles. It explains the general need to validate reimbursement, suggests broad monitoring priorities, and notes a CMS system change affecting how drug pricing and payment status are handled. The discussion is relevant to professionals tracking OPPS updates, HCPCS-based drug payment activity, and related CMS transmittals.
Why This Topic Matters
Quarterly payment updates can create reimbursement variance for high-volume or high-cost drugs, so facilities need a practical way to monitor paid amounts against expected payment. The article highlights why drug payment review matters for outpatient revenue integrity and compliance awareness.
What You Will Learn
- Why quarterly drug payment updates can affect outpatient reimbursement
- How facilities may prioritize monitoring of drug payments at a high level
- What general CMS system change is affecting outpatient drug payment processing
- Why validating payment after system changes is important for revenue integrity
Who Should Read This
- Hospital outpatient coders
- Revenue integrity staff
- Pharmacy directors
- Outpatient reimbursement specialists
- Billing and coding managers
Codes Discussed
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